M4 here in specialty selection crisis

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FutureDoctor317

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I am one of the rare types of medical students who enjoyed both surgery and internal medicine and cannot decide between the two. Any thoughts would be helpful

Surgery: Pros- immediate results, feels like you are accomplishing something every day. I have a surgeon personality (good work ethic, efficiency, like the military like surgical hierarchy). Less mid-level encroachment. More money.
Cons- Lifestyle (although right now i don't mind it at all, maybe I will later on in my life when I have kids), dealing with bad results (this is probably the biggest con for me, I feel like its going to effect me emotionally for a long time), I enjoy learning about pharm, phys, and path more so than anatomy or surgical techniques. Possibility of getting bored doing the same 5-10 procedures you specialize in for the rest of your life.

Medicine: Pros- intellectually stimulating, lots of cool fellowships to chose from (did a cardio rotation and absolutely loved it). Department of medicine seems more supportive of students then the department of surgery. Don't actually mind rounding like most people do. Feel like a complete doctor
Cons- More prone to midlevels, not as much money. I felt like my personality was more similar to surgeons then IM doctors. Don't think I would enjoy being a hospitalist or practicing general outpatient IM since it felt like I wasn't really accomplishing much throughout the day.Sometimes inpatient IM makes me feel like I am doing all the scut work while the subspecialists come in and actually treat the patient.

It's getting pretty late and I pretty much have to decide within the next week or so. I have my application set up for IM right now, but can easily change to GS, since several attendings have already agreed to write LORs for me.

Also one more question, how hard is it to switch after intern year from IM to GS, or vice versa
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Not to sidetrack this thread, but is "susceptibility to midlevels" that big an issue for IM Subspecialties? I thought it was mostly a problem for FM, Anes, and Psych.
 
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so you're deciding between g-surg and IM?

good luck man.

ever thought about something that combines the intellectual and procedural aspects of each into a financially viable and decent lifestyle specialty such as Anesthesia or Emergency Medicine?
 
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e30ftw said:
so you're deciding between g-surg and IM?

good luck man.

ever thought about something that combines the intellectual and procedural aspects of each into a financially viable and decent lifestyle specialty such as Anesthesia or Emergency Medicine?
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I had the same problem as the original poster and am trying to make EM the bridge. Good pay, lots of procedures, and I love working nights. There's just not enough exposure in med school to make a well informed decision.
 
I didn't really read your post beyond seeing that you are deciding between surgery and something else. Having seen what surgery residency does to people I care about, I would suggest opting for the non-surgery choice if you have ANY doubts at all or if there is anything else you could possibly see yourself doing. I can't imagine going through a GS residency, and especially going through it with what-ifs popping up in your mind everyday.

I wouldn't let money guide this one bit. In 10-20 years the difference will probably be negligible. IM can provide you with even more money than GS if that's what you are after.

I would also look at family medicine. In less populated areas, the family doctor can pretty much do whatever he wants, if procedures are your things. Decide what you want to manage and what you want to refer out. It's up to you. Great field.
Good luck.
 
Arkangeloid said:
Not to sidetrack this thread, but is "susceptibility to midlevels" that big an issue for IM Subspecialties? I thought it was mostly a problem for FM, Anes, and Psych.
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It's not a big issue in general, but midlevels are around everywhere. Lots of cards, GI, pulm PA/NPs are popping up.
 
Money isn't really a huge factor in my decision. Even if IM and GS were paid exactly the same I would still be sitting here trying to decide which one to go into. EM and family medicine really aren't for me as eventually (whether after GS or IM) I would like to become an expert in a narrow field rather than know a little bit about everything. At this point it's too late to explore anesthesia, although I wish I did an elective in it earlier on. Biggest thing holding me back from IM is that I cannot see myself enjoying the residency or being a hospitalist all that much. The mentality would be going into IM in order to become a cardiologist, GI, or pulm/cc doc. I am not sure if that is the right mentality for going into IM, as most people tell me you need to like it to be good at it. On the other hand if I go into GS, I know I will definitely enjoy the OR, however I think I'll miss some of the intellectual parts of medicine that GS really doesn't care about.
 
go with surgery

the lifestyle improvement isn't too drastic
you aren't going from surgery to path
 
thefritz said:
I didn't really read your post beyond seeing that you are deciding between surgery and something else. Having seen what surgery residency does to people I care about, I would suggest opting for the non-surgery choice if you have ANY doubts at all or if there is anything else you could possibly see yourself doing. I can't imagine going through a GS residency, and especially going through it with what-ifs popping up in your mind everyday.
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Completely agree with this.

Just my two cents, OP, but surgery is for those who literally want to be surgeons to the exclusion of everything else. It's just too much of an opportunity cost otherwise.
 
thefritz said:
I didn't really read your post beyond seeing that you are deciding between surgery and something else. Having seen what surgery residency does to people I care about, I would suggest opting for the non-surgery choice if you have ANY doubts at all or if there is anything else you could possibly see yourself doing. I can't imagine going through a GS residency, and especially going through it with what-ifs popping up in your mind everyday.

Good luck.
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Although I agree with this somewhat. I had some doubts when applying to medical school and people were saying the same thing. I ended up absolutely loving medical school and would go through it again in a heartbeat. That being said, I think what-ifs are going to be popping in my head either way. As a surgeon my thinking is going to be man I should have became an internist, they are so smart and can pretty much manage almost any disease, whereas I am stuck doing the same thing in the OR over and over again. As an Internist, I see myself thinking, man I should have become a surgeon they are able to cure patients within hours whereas all I do is tons of paperwork and prescribe a bunch of medications that may or may not help people months down the line.

Lol I feel like I am setting myself up for a miserable life either way
 
FutureDoctor317 said:
As a surgeon my thinking is going to be man I'm glad I didn't become an internist, all they do is tons of paperwork and prescribe a bunch of medications that may or may not help people months down the line, whereas I am able to cure patients within hours! As an Internist, I see myself thinking, man I'm glad I never became a surgeon. They are stuck doing the same thing in the OR over and over again whereas I am so smart and can pretty much manage almost any disease.

Lol I feel like I am setting myself up for a great life either way
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Fixed it for you :D
 
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ChanHoParkMD said:
If you haven't heard about it take this specialty test to learn more about tendencies of physicians already in the field. This might give your more insight to your situation.

http://www.med-ed.virginia.edu/specialties/
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Took it last week. Urology was number 1 and cardio was number 2. So not exactly helping my cause, although i found it pretty accurate since i find both of those fields very interesting.
 
FutureDoctor317 said:
Although I agree with this somewhat. I had some doubts when applying to medical school and people were saying the same thing. I ended up absolutely loving medical school and would go through it again in a heartbeat. That being said, I think what-ifs are going to be popping in my head either way. As a surgeon my thinking is going to be man I should have became an internist, they are so smart and can pretty much manage almost any disease, whereas I am stuck doing the same thing in the OR over and over again. As an Internist, I see myself thinking, man I should have become a surgeon they are able to cure patients within hours whereas all I do is tons of paperwork and prescribe a bunch of medications that may or may not help people months down the line.

Lol I feel like I am setting myself up for a miserable life either way
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1. Going by this thread, you'll what-if yourself no matter what. I say this because I thought the same way and what-if myself now. Helps to accept that.

2. About thinking the same thing about going to med school: apples and oranges. Medical school is four years of basic sciences, diverse clinical rotations, and basically makes you an undifferentiated physician who can end up spending his time seeing 40 patients a day in a busy, rural family medicine clinic where he works the same kind of hours he had during busier residency months, or part-timing a small ED somewhere where he actually has some downtime and works far fewer hours in a week than the FM guy ever will. Meanwhile, A five-year general surgery residency prepares you to be a general surgeon for the next few decades.

You're a fourth year -- you've been through both surgery and IM, so you have a good idea of what they do. I always felt like no matter what we pick, there will be monotony to it down the road. Might as well pick the thing that you feel will let you be the happiest... and that includes your life outside of your work.
 
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thefritz said:
I didn't really read your post beyond seeing that you are deciding between surgery and something else. Having seen what surgery residency does to people I care about, I would suggest opting for the non-surgery choice if you have ANY doubts at all or if there is anything else you could possibly see yourself doing. I can't imagine going through a GS residency, and especially going through it with what-ifs popping up in your mind everyday.
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exi said:
Completely agree with this.

Just my two cents, OP, but surgery is for those who literally want to be surgeons to the exclusion of everything else. It's just too much of an opportunity cost otherwise.
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I disagree with both of these statements. While there are some residents and attendings who just live and breathe surgery, there are a lot of people in surgery who picked it for practical reasons. The whole "if you're interested in anything else at all, don't do surgery" mantra is over-exaggerated and not very useful for the real world, IMHO. Plenty of the surgery residents and attendings on my rotation don't live and die by surgery -- they like that they get to work with their hands a lot and get satisfaction from quick results.

Every field gets monotonous once you get good at it. You won't avoid this in any specialty. Just pick what bread and butter stuff you'd be happy dealing with 20 years from now. Work hours are definitely a concern, but they're more of an issue during residency, which is limited. If I end up really enjoying a field, I'd be willing to put up with a few tough years if it means I get to do something I find interesting and satisfying for the rest of my life.
 
Urology was my vote before I saw the results of your test. Talk with a few if you haven't. You might be surprised.
 
Moki said:
Urology was my vote before I saw the results of your test. Talk with a few if you haven't. You might be surprised.
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If someone handed me a spot in Urology today I would take it in a heartbeat. However it's way too competitive of a field to try to break into a month before applications are due
 
I support surgery since that what I did. The biggest reason I chose it over anything in medicine is the chance to truly cure people of their illnesses. It's discouraging on medicine to have people come in with 9 problems and discharged with 6 to follow up in clinic for the management of those often chronic problems. Surgery is very problem focused which is what originally attracted me to it. Yes I get jealous when the FM or IM residents come in at 7 and leave at 5 but it's also gratifying to get calls from them when they don't know what else to do and then they consult us to fix their patient! ;)
 
krafty934 said:
I disagree with both of these statements. While there are some residents and attendings who just live and breathe surgery, there are a lot of people in surgery who picked it for practical reasons. The whole "if you're interested in anything else at all, don't do surgery" mantra is over-exaggerated and not very useful for the real world, IMHO. Plenty of the surgery residents and attendings on my rotation don't live and die by surgery -- they like that they get to work with their hands a lot and get satisfaction from quick results.
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What specialty are you applying to / planning on applying to, and out of curiosity, what do you consider to be a practical reason for choosing a specialty?
 
Crap! (I meant to quote OP's response...probably makes more sense with it, but unfortunately I don't know how/have the energy at the moment to fix it. Sorry)
 
FutureDoctor317 said:
Although I agree with this somewhat. I had some doubts when applying to medical school and people were saying the same thing. I ended up absolutely loving medical school and would go through it again in a heartbeat. That being said, I think what-ifs are going to be popping in my head either way. As a surgeon my thinking is going to be man I should have became an internist, they are so smart and can pretty much manage almost any disease, whereas I am stuck doing the same thing in the OR over and over again. As an Internist, I see myself thinking, man I should have become a surgeon they are able to cure patients within hours whereas all I do is tons of paperwork and prescribe a bunch of medications that may or may not help people months down the line.

Lol I feel like I am setting myself up for a miserable life either way
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Not sure why you think it would be all the same case over and over again. There's actually a LOT of variety/subtleties that keep things interesting in surgery. Internists deal with HTN/DM/asthma/hyperlipidemia over and over again but they do get some other stuff thrown in, too. Every field has their own "bread and butter" as they say.

If you are really unsure, pick a procedural IM subspecialty like GI....you can scope and do interventional stuff and work with both surgeons and internists to figure out the strange diagnoses.
 
krafty934 said:
Work hours are definitely a concern, but they're more of an issue during residency, which is limited. If I end up really enjoying a field, I'd be willing to put up with a few tough years if it means I get to do something I find interesting and satisfying for the rest of my life.
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I wouldn't be so quick to dismiss the work hours... I've heard more than a couple attendings note that their work hours increased after residency.
 
mvenus929 said:
I wouldn't be so quick to dismiss the work hours... I've heard more than a couple attendings note that their work hours increased after residency.
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More likely a choice than an obligation.
 
Can someone explain to me what exactly a transitional year is and if it would be a smart choice for someone like me? It seems like people going into fields like anesthesia, rads, rad onc, derm, pm&r and etc. do a transitional year before starting their residencies. I hear that it's moderately competitive and there aren't too many spots out there. People describe it as basically another year of M4. Would a transitional year allow me to do electives in medicine and surgery and basically give me another year to ultimately decide? Would I still be as competitive or is it looked down upon in medicine and surgery? I am assuming transitional year will not count as an intern year in IM or GS, is this correct?
 
No, TYs are NOT made for people to rotate and decide to choose between medicine or surgery. TYs are mainly for the residencies that start as a 2nd year and need one intern year.
 
FutureDoctor317 said:
I am one of the rare types of medical students who enjoyed both surgery and internal medicine and cannot decide between the two. Any thoughts would be helpful

Surgery: Pros- immediate results, feels like you are accomplishing something every day. I have a surgeon personality (good work ethic, efficiency, like the military like surgical hierarchy). Less mid-level encroachment. More money.
Cons- Lifestyle (although right now i don't mind it at all, maybe I will later on in my life when I have kids), dealing with bad results (this is probably the biggest con for me, I feel like its going to effect me emotionally for a long time), I enjoy learning about pharm, phys, and path more so than anatomy or surgical techniques. Possibility of getting bored doing the same 5-10 procedures you specialize in for the rest of your life.

Medicine: Pros- intellectually stimulating, lots of cool fellowships to chose from (did a cardio rotation and absolutely loved it). Department of medicine seems more supportive of students then the department of surgery. Don't actually mind rounding like most people do. Feel like a complete doctor
Cons- More prone to midlevels, not as much money. I felt like my personality was more similar to surgeons then IM doctors. Don't think I would enjoy being a hospitalist or practicing general outpatient IM since it felt like I wasn't really accomplishing much throughout the day.Sometimes inpatient IM makes me feel like I am doing all the scut work while the subspecialists come in and actually treat the patient.

It's getting pretty late and I pretty much have to decide within the next week or so. I have my application set up for IM right now, but can easily change to GS, since several attendings have already agreed to write LORs for me.

Also one more question, how hard is it to switch after intern year from IM to GS, or vice versa
Click to expand...

Why do Program Directors expect us to be so committed to a specialty we haven't even completed a year of training in?

PDs are so intent on finding someone who is passionate about their specialty... This is frustrating. I don't care what specialty I end up in. They all permit me to use my medical knowledge to help humankind.
 
Diagnose said:
Why do Program Directors expect us to be so committed to a specialty we haven't even completed a year of training in?

PDs are so intent on finding someone who is passionate about their specialty... This is frustrating. I don't care what specialty I end up in. They all permit me to use my medical knowledge to help humankind.
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Probably cuz they want to minimize attrition.
 
I would say choose General surgery, which gives you 5 years of GME funding.

By your PGY2 year, you'll probably know if you want to stick around and still have 3 years of funding to cover IM training if you so decide.

Also, have you considered a critical care fellowship after GNS training? They are like internist for really sick patients in the SICU

Im not sure where this say comes from: " A surgeon is an internist who can operate"
 
yearn4ivy said:
I would say choose General surgery, which gives you 5 years of GME funding.

By your PGY2 year, you'll probably know if you want to stick around and still have 3 years of funding to cover IM training if you so decide.

Also, have you considered a critical care fellowship after GNS training? They are like internist for really sick patients in the SICU

Im not sure where this say comes from: " A surgeon is an internist who can operate"
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Is that really true? Can you really game GME like that?
 
I had a similar albeit slightly different dilemma. I really enjoyed procedures and enjoyed working with my hands, but absolutely despised the hierarchy and often the egotistic mentality of surgeons - and at the same time I disliked rounding and dealing with certain medical issues but loved the ability to work up difficult patients and loved working with sick patients and getting them stable and better. Ultimately I went the IM route because I felt I'd be less miserable, didnt enjoy the OR as much as bedside/cath lab/endoscopy, and preferred more versatility in my work - which is why I want to do cardiology now with a good mix of inpatient, imaging, physiology and medicine, and intervention/operative stuff esp with EP.

OP my two cents is you might be happier going through IM and picking a subspecialty like GI, cardiology, or Pulm/cc, all of which have significant interventional aspects (even Pulm has a new interventional pulmonology field where you do tumor ablations, bronchs, trachs, chest tubes, and a whole bunch of crazy thoracic procedures).

In either field you are going to see a lot of the same crap over an over again. It's whether you'd rather see one type of thing repeatedly over the other. I would much rather deal with ARDS, STEMIs, arrhythmias and cancers than deal with choles and hernias. The training time isn't much different either anymore now that most specialties are encouraging further subspecializing especially medicine and surgery.
 
yearn4ivy said:
I would say choose General surgery, which gives you 5 years of GME funding.

By your PGY2 year, you'll probably know if you want to stick around and still have 3 years of funding to cover IM training if you so decide.

Also, have you considered a critical care fellowship after GNS training? They are like internist for really sick patients in the SICU

Im not sure where this say comes from: " A surgeon is an internist who can operate"
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That might have been true back in the day but most surgeons I know will turf medical problems to medicine while focusing much more purely on the operative aspect of their field. However that is the way modern medicine works nowadays for better or for worse
 
I may be mistaken, but my understanding is that when you match into a categorical spot in say IM, you are given 3 years of GME funding, wherease GNS gets 5 years.

The funding issue arises if you are in IM and decide to switch to GNS; this may leave you with a 2 year funding deficit. Hence, why it may be better to match into GNS.

My medicine attending who was originally a GNS resident mentoined this. I also believe I read it some AAMC sponsored website: careers in medicine maybe?

I guess the best way to know is ask a program director I guess
 
yearn4ivy said:
I may be mistaken, but my understanding is that when you match into a categorical spot in say IM, you are given 3 years of GME funding, wherease GNS gets 5 years.

The funding issue arises if you are in IM and decide to switch to GNS; this may leave you with a 2 year funding deficit. Hence, why it may be better to match into GNS.

My medicine attending who was originally a GNS resident mentoined this. I also believe I read it some AAMC sponsored website: careers in medicine maybe?

I guess the best way to know is ask a program director I guess
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One of our program directors here explained it to me exactly like this. I don't have any factual evidence I guess.
 
Everyone should just apply to neurosurgery, then...Just in case...
 
I think I am just going to apply to both and let the match make my decision for me. That way at least I wont blame myself if I end up hating my career.
 
FutureDoctor317 said:
I think I am just going to apply to both and let the match make my decision for me. That way at least I wont blame myself if I end up hating my career.
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What if you match at your number 1? :p
 
tco said:
What if you match at your number 1? :p
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Good point, I guess it gives me a couple more months to think about it. I think I am going to apply to both and do a medicine subi in september and a surgery subi in october. By the end of that I should have my decision. Its gonna be a lot of work though. I'm not sure how the department of surgery or the department of medicine is going to feel about this game plan
 
FutureDoctor317 said:
Good point, I guess it gives me a couple more months to think about it. I think I am going to apply to both and do a medicine subi in september and a surgery subi in october. By the end of that I should have my decision. Its gonna be a lot of work though. I'm not sure how the department of surgery or the department of medicine is going to feel about this game plan
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Who cares what they think? You have to do what's best for you.
 
FutureDoctor317 said:
Good point, I guess it gives me a couple more months to think about it. I think I am going to apply to both and do a medicine subi in september and a surgery subi in october. By the end of that I should have my decision. Its gonna be a lot of work though. I'm not sure how the department of surgery or the department of medicine is going to feel about this game plan
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how did the surgery residents/attendings not allay your fears of surgery residency?

surgery has a ton of variation so it isn't a mundane procedural job with no thought required
surgery has tons of people who aren't workaholics and manage to survive

match GNS
 
Amazingmuzmo said:
Do a procedural based subspecialty within IM (ie gastroenterology).
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This! In GI/invasive cards ect, you get higher pay, intellectual stimulation, no encroachment of midlevels, no GS residency, better hours, basically everything you want and none of what you don't.
 
Unzbuzzled said:
Do you think midlevels will eventually infringe upon specialties? Doesn't that defeat the purpose of a specialist?
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Of course, but it depends on the specialty.

I think it will be a very long time until you see midlevels doing bread and butter neurosurg procedures. ;)
 
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